medwireNews: The use of glucagon-like peptide (GLP)-1 receptor agonists prior to emergency surgery does not put patients with type 2 diabetes at increased risk for postoperative respiratory complications, suggest findings in a research letter published in JAMA.
A nonsignificant difference in the risk for postoperative respiratory complications was observed in individuals receiving GLP-1 receptor agonists compared with those receiving other types of antidiabetic agents, at 3.5% versus 4.0%.
“[T]he American Society of Anesthesiologists issued guidelines recommending preoperative withholding of [GLP-1 receptor agonists], used for type 2 diabetes management and weight loss,” explain the researchers.
They note that while “preoperative medication guidelines can prevent complications, withholding medications can also result in adverse effects,” such as cancelled procedures, significant delays in receiving care, and financial losses due to unused operating room time.
“These downsides are pronounced for GLP-1 [receptor agonists] due to recommended withholding periods of up to a week,” note Anjali Dixit (Stanford University School of Medicine, California, USA) and colleagues.
The researchers collated information for 23,679 patients enrolled in the Merative MarketScan Commercial Database who had undergone emergency surgery between January 2015 and December 2021, 3502 of whom had filled a prescription for a GLP-1 RA prior to surgery. Patients who had filled a GLP-1 RA prescription were slightly more likely than those who had not to be men (50.9 vs 45.5%), to have obesity (51.9 vs 41.6%), and to have received a higher number of diabetes agents on average (2.4 vs 1.5).
The endpoint comprised postsurgical respiratory failure, aspiration pneumonitis, and/or admission to intensive care unit within the first 7 days of surgery. There was no significant increased risk for these outcomes with versus without GLP-1 receptor agonist use after multivariable logistic regression analysis considering demographic factors, surgery type, and markers of diabetes severity. Nor was there an increased risk when considering only pulmonary aspiration and respiratory failure, or when restricting the analysis to patients with a low risk for aspiration and postoperative complications.
The authors say that“[g]iven increasing use of GLP-1 RAs, larger-scale evaluations of their perioperative risks are needed.”
Nevertheless, Dixit et al observe: “Results of this study suggest that liberalizing the withholding guidelines for GLP-1 [receptor agonists] preoperatively should be considered.”
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